Is There a Role for Surgery in the Management of Gestational Trophoblastic Neoplasia

Background: Gestational trophoblastic diseases are treated with chemotherapy, but some patients are resistant to it and require surgeries. The role of surgery in the management of these patients is not clearly defined. This study aimed to evaluate the role of surgery in the management of patients with gestational trophoblastic tumor (GTN).  Method: This cohort study was performed on patients with GTN referred during June 2009 to June 2019. The patients receiving hysterectomy, hysterotomy to remove uterine lesion, pulmonary lobectomy, craniotomy, and other surgical procedures were included in the study. The surgery indications were resistant to chemotherapy or hemorrhage. Results: The survival rate of the 31 patients that entered the study was 100%. The mean age of patients was 36 years. The frequency of surgeries were as follow: hysterectomy in 21 patients (67.7%), hysterotomy in six patients (19.4%), removal of lung lesion in three patients (9.7%), and craniotomy in one patient (3.2%). Among the patients, 22 showed complete response to treatment and nine patients had relative response. The relation between response to surgery with variables, such as the type of previous pregnancy, disease pathology, the scoring of disease in World Health Organization (WHO) system, the severity of disease based on The International Federation of Gynecology and Obstetrics (FIGO) stage, and the need to chemotherapy sessions, were significant. Conclusion: Surgery played an important role in management of patients with GTD. Previous non-molar pregnancy, stage, and WHO score based on clinical factors affected the response rate of treatment.